手术对广泛期小细胞肺癌患者生存的影响:基于SEER数据库的倾向得分匹配分析

Effect of surgery on survival in patients with extensive small cell lung cancer:a SEER database-based propensity scores matching analysis

目的:探讨手术治疗与非手术治疗对广泛期小细胞肺癌(ES-SCLC)患者的影响。方法:收集SEER数据库2004—2015年共24677例ES-SCLC患者并将其分为手术组和非手术组,通过倾向得分匹配分析消除两组间的偏差,用Kaplan-Meier生存分析比较两组的生存情况,利用Log-rank单因素分析和多因素Cox回归对ES-SCLC患者进行校正并进行亚组分层分析。结果:倾向得分匹配后各有249例患者纳入手术组和非手术组,两组Kaplan-Meier生存曲线显示手术组预后较好且有统计学意义(χ^2=13.367,P<0.001)。手术组中,接受肺叶切除术者比接受肺段、全肺切除术者预后生存率更佳(χ^2=16.447,P<0.001)。单因素和多因素分析结果显示,手术治疗是影响ES-SCLC患者预后的因素(χ^2=13.367,P<0.001)。亚组分析显示,≥60岁、N0和N1的手术组患者预后优于非手术组(χ^2=8.974、7.732、4.077,P=0.003、0.005、0.043),同时,无论是否化疗,手术组预后均优于非手术组(χ^2=8.072、4.104,P=0.004、0.043)。结论:手术总体上可以延长ES-SCLC患者的生存时间。

Objective:To investigate the effect of surgical treatment and non-surgical treatment on the prognosis of patients with extensive stage small cell lung cancer(ES-SCLC).Methods:A total of 24677 ES-SCLC patients from 2004 to 2015 were collected from SEER database and divided into surgery group and non-surgery group.Deviation between the two groups was eliminated by tendency score matching analysis.Survival of the two groups was compared by Kaplan-Meier survival analysis.The subgroup analysis was corrected and analyzed by Log-rank univariate analysis and multivariate Cox regression.Results:After propensity score matching,surgery group and non-surgery group each involved 249 patients.The difference between the two Kaplan-Meier survival curves was statistically significant(χ^2=13.367,P<0.001).In surgery group,patients with pulmonary lobectomy had a better survival rate than those who received segmentectomy or pneumonectomy(χ^2=16.447,P<0.001).Univariate and multivariate analysis showed surgery was an independent prognostic factor in patients with ES-SCLC(χ^2=13.367,P<0.001).In subgroup analysis,patients aged 60 or more and with stage N0 and N1 in surgery group had better prognosis than those in non-surgery group(χ^2=8.974,7.732,4.077,P=0.003,0.005,0.043).Meanwhile,regardless of whether patients received chemotherapy,there was difference between prognosis of surgery group and non-surgery group(χ^2=8.072,4.104,P=0.004,0.043)and the former was better.Conclusion:In general,the operation can prolong the survival time of ES-SCLC patients.